GPs 'must always consider cancer', says RCGP expert

Detecting cancers earlier remĀ­ains one of the toughest goals for general practice.

Professor Greg Rubin: start from point of suspecting cancer (Photograph: RCGP)
Professor Greg Rubin: start from point of suspecting cancer (Photograph: RCGP)

So when the RCGP asked Durham University’s Professor Greg Rubin, a former GP, to help tackle the issue he decided fresh tactics were needed.

‘It’s that perennial challenge,’ he says. ‘It’s rare to see a patient with cancer, but common to see patients with symptoms that might be cancer.’

Professor Rubin will lead a drive to bring cancer to the forefront of primary care work. This aligns with the DH’s aim to save 5,000 lives a year by improving early diagnosis.

The vital signs are healthy: an RCGP audit last year found 75% of all cancers in 2009/10 were referred for investigation within two GP consultations.

But rising survival rates mask a growing incidence of preventable cancers caused by poor lifestyle, which now exceed 100,000 cases a year.

Improving early diagnosis
So how can early diagnosis improve further when a GP may see some types of cancer only once in their career?

Professor Rubin says GPs must learn to think about cancer every time they consider symptoms. ‘GPs must start from the point of suspecting cancer,’ he says.

‘Our job is to have the suspicion of cancer and ground that suspicion on efficient assessment of patients and symptoms and risks.’

The RCGP will build a package of GP education around this approach, updating GP training, appraisal and revalidation. Computer-based algorithms will be key, too.

But Professor Rubin says an uneasy clash remains between the use of costly diagnostic scans and the need to tighten NHS purse strings.

‘There rem­ains a tension between referring people at lower thresholds of suspicion and the pressures of the Quality, Innov­ation, Productivity and Prevention (QIPP) agenda.

'But you have to balance that against wanting to reduce the number of cancers as emerg­ency presentations, which leads to more expensive and worse outcomes.’

In February, res­earchers said GPs must have greater access to tests and screening tools to cut large reg­ional differences in speed of dia­gnosis.

Professor Rubin says DH guidance last week on when GPs should inv­estigate vague cancer symptoms will reassure them that use of scans is offically ‘validated’. But improving access is ‘essential’ he says.

Commissioners and politicians will continue to spar. But Professor Rubin says: ‘GPs do a really good job on diagnosing cancer, but we’d all like to do a perfect job. We’re striving to do the best we can.’

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GPs face tax problems as missed pension deadline forces PCSE apology

GPs face tax problems as missed pension deadline forces PCSE apology

Many GPs could struggle to plan for retirement after Primary Care Support England...

Patients who refuse to wear a mask could be denied face-to-face GP appointment

Patients who refuse to wear a mask could be denied face-to-face GP appointment

Patients who refuse to wear a face covering when attending a GP practice could be...

No plans for most GPs to open over August bank holiday, NHS England confirms

No plans for most GPs to open over August bank holiday, NHS England confirms

GP practices will not be asked to work over the August bank holiday unless they are...

More than one in five GPs have had COVID-19, poll suggests

More than one in five GPs have had COVID-19, poll suggests

More than one in five GPs may have had COVID-19, according to a BMA survey that shows...

Half of GP partners believe PCNs will improve patient care in the coming year

Half of GP partners believe PCNs will improve patient care in the coming year

Over half of GP partners believe primary care networks (PCNs) will have a positive...

GPs call for PCN mental health recruitment to be fast-tracked as cases surge

GPs call for PCN mental health recruitment to be fast-tracked as cases surge

Primary care networks (PCNs) must not be forced to wait until 2021 to recruit mental...